Dental Board of California
Licensing details for: 16528
Name: COSTA MESA ORAL SURGERY DENTAL PRACTICE OF LEE D. PHAM, DDS, MD, INC. AND HEENA CHANDRA, DDS, INC.
License Type: Fictitious Name Permit
Primary Status: Current - Active
Organization Classification: Partnership
Previous Names: COSTA MESA ORAL SURGERY DENTAL PRACTICE OF LEE PHAM, DDS, MD AND HEENA CHANDRA, DDS, MD
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: CHANDRA, HEENA JAI
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: PHAM, LEE DUONG
Address Not Disclosed
FNP to DDS or OMS
License/Registration Role: Fictitious Name Permit
Related Party Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit
Name: PHAM, LEE DUONG
License/Registration Type: Dentist License
License Number: 55453 Primary Status: Current - Active
Address :
4582 KATELLA AVENUE
LOS ALAMITOS CA 90720
ORANGE COUNTY
FNP to DDS or OMS
License/Registration Role: Fictitious Name Permit
Related Party Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit
Name: CHANDRA, HEENA JAI
License/Registration Type: Dentist License
License Number: 58092 Primary Status: Current - Active
Address :
4582 Katella Ave
LOS ALAMITOS CA 90720
ORANGE COUNTY
